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2nd TURBT for non invasive high grade bladder cancer

1 week 3 days ago #56341 by Alan
Just giving you some extra reassurance that a second TURB is almost always done as a safety issue by urologists. I had the same questions but, I have learned from many people it is the right call. On the histopathology report. None of us are doctors so it is above at least my knowledge. It is good to keep a copy of it. Pat yourself on the back as the caregiver is so often overlooked as an integral part of the team! It sounds like you have a good URO. Most of us also say if any doubts a second opinion can be done for peace of mind.

DX 5/6/2008 TAG3 papillary tumor .5 CM in size. 2 TURBS followed by 6 instillations of BCG weekly with a second round of 6 after a 6 week wait.

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1 week 3 days ago #56340 by atifabrar
My father doesn't even know that there is some kind of malignancy. We have deliberately decided to hide it from him because he is highly sensitive and would go in a depression mode if he comes to know about malignancy. However I have told him that these tumors tend to recur and we need to comply to the treatment strictly. Coming back to second TURBT, the urologist who performed the first resection will not acknowledge that the resection was not adequate because that will raise questions on his ability. But as a general protocol, some doctors are doing a second resection to be doubly sure about staging. Now I am not sure about the non invasive tumor which might turn into invasive during BCG treatment because of not performing second TURBT.
One more query. We performed the first surgery on Nov 15 and on Nov 29 we had his routine Urine examination done and it showed 80 pus cells and 40 RBCs. Is it a matter of concern? He is off antibiotics since a week.

I am attaching the histopathology report and the post operative findings
Attachments:

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1 week 3 days ago - 1 week 3 days ago #56339 by sara.anne
Welcome to the Forum! You have some really good questions.

You mentioned that your father’s diagnosis was “ high grade.” Did the pathology report mention carcinoma in situ (CIS?). CIS is always high grade and BCG is the treatment of choice for it and high grade papillary bladder cancer. CIS appears like a rash on the bladder lining and would be difficult to remove completely during a TURB.

Often a second TURB is done if there is any uncertainty about the diagnosis such as not having enough surrounding tissue in the sample to determine if there has been any involvement of the muscle. In my case the pathology came back low grade with some areas of undefined irritation The urologist went back and did a second TURB paying special attention to the areas under question and the diagnoses thern came back carcinoma in situ which was a much different situation than the initial report indicated.

If his current urologist has any indication that tumor tissue was left behind or that the staging was not adequate of course he should do a second TURB. It is a judgment call on the part of the urologist and since a TURB is done under general anesthetic it is not something that is done without a good reason. If your father is otherwise happy with the initial doctor, I wold have a frank talk with him about this before he makes a decision. Ask him about the need for a second TURB.

The results of the urine cytology tests are something else. Urine cytology is a diagnostic aid but has some problems. It has the unfortunate reputation for giving false positive results indicating the presence of cancer when there is none. Since your father had just had a TURB
it is possible that there are damaged cells present which are showing up on the cytology as malignant. Cytology results are never used in isolation to make a diagnosis.

This is a decision that your father is going to have to decide once he has all the information.

Let us know what he decides!

Sara Anne

Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society
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1 week 3 days ago #56338 by atifabrar
My dad has been diagnosed with non invasive high grade urothelial carcinoma. He underwent TURBT couple of weeks back and now doctors have set up dates for his BCG treatment. However, I found an alternate view from another senior doctor that before the BCG is started, second TURBT should be performed after 6 weeks of first TURBT to be sure about the staging of tumor and also see if any residual tumor has been left behind. He also did a urine cytology and the resports suggested positive for malignant cells even after first TURBT. He is 72 male with hypertension and diabetes. Please suggest whether second TURBT should be perdormed or not.

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